Al-Qadhi Waleed, Ur Rahman Saeed, Ferwana Mazen S, Abdulmajeed Imad Addin
Board Eligible Resident, Family Medicine Department, King Abdulaziz Medical City-National Guard, Riyadh, Saudi Arabia.
BMC Psychiatry. 2014 Jul 3;14:190. doi: 10.1186/1471-244X-14-190.
By the year 2020 depression would be the second major cause of disability adjusted life years lost, as reported by the World Health Organization. Depression is a mental illness which causes persistent low mood, a sense of despair, and has multiple risk factors. Its prevalence in primary care varies between 15.3-22%, with global prevalence up to 13% and between 17-46% in Saudi Arabia. Despite several studies that have shown benefit of early diagnosis and cost-savings of up to 80%, physicians in primary care setting continue to miss out on 30-50% of depressed patients in their practices.
A cross sectional study was conducted at three large primary care centers in Riyadh, Saudi Arabia aiming at estimating point prevalence of depression and screening cost among primary care adult patients, and comparing Patient Health Questionnaires PHQ-2 with PHQ-9. Adult individuals were screened using Arabic version of PHQ-2 and PHQ-9. PHQ-2 scores were correlated with PHQ-9 scores using linear regression. A limited cost-analysis and cost saving estimates of depression screening was done using the Human Capital approach.
Patients included in the survey analysis were 477, of whom 66.2% were females, 77.4% were married, and nearly 20% were illiterate. Patients exhibiting depressive symptoms on the basis of PHQ9 were 49.9%, of which 31% were mild, 13.4% moderate, 4.4% moderate-severe and 1.0% severe cases. Depression scores were significantly associated with female gender (p-value 0.049), and higher educational level (p-value 0.002). Regression analysis showed that PHQ-2 & PHQ-9 were strongly correlated R = 0.79, and R2 = 0.62. The cost-analysis showed savings of up to 500 SAR ($133) per adult patient screened once a year.
The point prevalence of screened depression is high in primary care visitors in Saudi Arabia. Gender and higher level of education were found to be significantly associated with screened depression. Majority of cases were mild to moderate, PHQ-2 was equivocal to PHQ 9 in utility and that screening for depression in primary care setting is cost saving.
据世界卫生组织报告，到2020年抑郁症将成为导致伤残调整生命年损失的第二大主要原因。抑郁症是一种导致持续情绪低落、绝望感且有多种风险因素的精神疾病。其在初级保健中的患病率在15.3%至22%之间，全球患病率高达13%，在沙特阿拉伯为17%至46%。尽管多项研究表明早期诊断有益且可节省高达80%的成本，但初级保健机构的医生在其诊疗中仍会漏诊30%至50%的抑郁症患者。
在沙特阿拉伯利雅得的三个大型初级保健中心进行了一项横断面研究，旨在估计初级保健成年患者中抑郁症的时点患病率和筛查成本，并比较患者健康问卷PHQ - 2和PHQ - 9。使用阿拉伯语版的PHQ - 2和PHQ - 9对成年个体进行筛查。使用线性回归分析PHQ - 2得分与PHQ - 9得分的相关性。采用人力资本方法对抑郁症筛查进行了有限的成本分析和成本节约估计。
纳入调查分析的患者有477名，其中66.2%为女性，77.4%已婚，近20%为文盲。根据PHQ9表现出抑郁症状的患者占49.9%，其中轻度占31%，中度占13.4%，中度至重度占4.4%，重度占1.0%。抑郁得分与女性性别（p值0.049）和较高教育水平（p值0.002）显著相关。回归分析表明PHQ - 2和PHQ - 9高度相关，R = 0.79，R2 = 0.62。成本分析显示，每年对每位成年患者进行一次筛查可节省高达500沙特里亚尔（133美元）。
在沙特阿拉伯，初级保健就诊者中筛查出的抑郁症时点患病率较高。发现性别和较高教育水平与筛查出的抑郁症显著相关。大多数病例为轻度至中度，PHQ - 2在效用上与PHQ - 9相当，且在初级保健机构筛查抑郁症具有成本效益。
